Pulmonary & Sleep Services

Severely damaged and unhealthy lungs make individuals difficult to breathe and dependent on continuous oxygen support. The limitation of oxygen to the body makes it difficult for the organs to function effectively and reduces life expectancy.

The surgery is recommended only after all the alternative means of treatment have been utilized and the life expectancy without transplant is calculated to be less than 2 years.

Some of the common indications but not restricted to are as follows:

• Pulmonary Fibrosis: Scarring of the lungs leading to its shrinkage from any cause including COVID-19 pneumonia, connective tissue related or idiopathic.
• Chronic Obstructive Pulmonary Disease(COPD): Damage to the small airways and lung cells(alveoli) due to exposure to smoke, pollutants etc.
• Bronchiectasis: Destruction of the large airways
• Cystic lung disease: Formation of multiple hollow cavities in the lungs from any cause
• Pulmonary hypertension: high pressure in the vessels of the lungs

There are 4 types of lung transplants:

• Double lung transplant: Both the patient's lungs are removed and replaced with the two donated lungs of a single deceased donor. This is the preferred option in the majority of cases.
• Single lung transplant: Single damaged lung (the worst of the two) is removed from the patient and replaced with a single lung from the donor. This is sometimes indicated in a few select cases.
• Lobar transplant: One or two lobes from the donor(s) are transplanted to the recipient. It is indicated in some cases of size discrepancies and pediatric patients.
• Combined Heart-lung Transplant: The heart and both lungs from the recipient are removed and replaced with a heart and two lungs from a single donor. This is indicated in persons with pulmonary vessel abnormalities or cases of end-stage heart and lung diseases

• Those with progressive end-stage lung disease who have exhausted all other forms of treatment.
• The patient's end-stage disease is not likely to recur within the next 5 years.
• There should not be any major comorbid illness like kidney or liver ailments limiting 5-year survival.
• They should not have any long-term active infection like hepatitis B or C.
• There should not have a history of any recent or active malignancy.
• No active substance abuse.
• There should be a reliable social support system.

• Lung transplant surgery is a complex surgery that carries a significant risk of complications
• Rejection : Your body's immune system recognizes the donated lungs as foreign and tries to reject them. Rejection implies the failure of the donor organ. You would be kept on immune-suppressive medications which will target to reduce rejection
• Infection : The transplant recipients are at increased risk for infection due to the lowering of immunity by medications. You would be required to maintain adequate hygiene all the time and have minimum social contact
• Blood clots in legs, stroke, clots in the vessels of the lungs and heart predominantly in the postoper-ative period
• Diabetes, bone thinning, or high cholesterol levels from the medicines
• Stomach upset, kidney injury or liver injury from anti-rejection drugs
• Increased risk of certain cancers
• Problems at the joining sites of the airways or blood vessels.

Types Of Rejection

• Acute rejection: Acute rejection can be due to many causes like infection, acid reflux or non-compliance with immunosuppressants. It requires adding on therapy for a short course of time. To identify it earlier, surveillance biopsies of the lung are done at specified intervals
• Chronic Rejection:This is due to a slow decline in lung function over a while. It can however have a rapid course in some patients warranting aggressive care.

• How much time does a lung transplant take?
  -The surgery generally takes 6-12 hours depending on the complexities involved with the patient.
• Can a person live with one lung?
  -Yes, provided it is functioning adequately.
• Does, diabetes and hypertension affect lung transplants?
  -Any additional illness associated with the patient affects depending on the severity of the associated illness.